The Price of Passing on Medicaid

Monday

Feb 4, 2013 at 10:01 AMFeb 4, 2013 at 10:03 AM

When one of Linn County’s new legislators visited Pershing Memorial Hospital last Thursday to discuss Medicaid expansion over lunch, he did so with a little skepticism but a lot of willingness to listen.

Chris Houston@LinnCoChris

When one of Linn County’s new legislators visited Pershing Memorial Hospital last Thursday to discuss Medicaid expansion over lunch, he did so with a little skepticism but a lot of willingness to listen. Pershing CEO Phil Hamilton shared some of 7th District Representative Mike Lair’s doubts about depending upon the federal government to keep struggling rural hospitals afloat, but stressed the importance of Medicaid expansion to Pershing Memorial even more vigorously. Like many hospital administrators throughout Missouri, Hamilton is anticipating the negative impact of the looming $4 billion in Medicare and Medicaid payment reductions that were part of the Affordable Care Act (ACA) and the Budget Control Act of 2011. When Medicare and Medicaid payment cuts from 2013 to 2019 were included in those pieces of federal legislation, the hope was that full participation in the ACA would mean such a substantial increase in the number of new, previously uninsured patients that the increased patient volume would more than offset the ‘entitlement’ payment cuts to come. But that hope was based upon the assumption that all of the states would participate in the Affordable Care Act. Since the passage of the ACA, however, 26 states have challenged its constitutionality, and the majority of the Missouri electorate has supported opting out of the federal health care law. Although the U.S. Supreme Court found the ACA to be constitutional, the highest court in the land ruled that the decision to expand Medicaid, which was also an important part of the ACA, would be left to the individual states. We asked Linn County’s trio of new legislators—7th District Rep. Mike Lair (R), 6th District Rep. Tim Remole (R), and Senator Brian Munzlinger (R)—where they stood on Medicaid expansion. During Friday’s luncheon at Pershing Memorial, Rep. Lair said he favored local solutions rather than a ‘federal takeover’ of health care, and assured, “We don’t want to take Medicaid coverage away from those who already have it.” Lair has added elsewhere, “I do not feel it [Medicaid expansion] is an either/or decision; there must be a compromise that can be reached between the Governor’s plan and a refusal to expand at all.”Rep. Remole responded by email, “My concerns with Medicaid expansion are similar to the ones echoed by the Governor himself in his State of the State address. He said he supports a rollback of the expansion if the federal government fails to live up to its end of the deal…The problem is that it may not be easy to undo an expansion if and when the federal government fails to fund it as promised.” Under the ACA, the federal government would fund 100 percent of Medicaid expansion for the first three years and no less than 90 percent in the years to follow. However, Rep. Remole is skeptical: “My biggest fear with adding 300,000 Missourians to the Medicaid rolls is that future generations of Missourians may be stuck with paying a bill they simply can’t afford…The people of my district sent me to Jefferson City to represent their interests, and I believe I’m doing that by opposing a misguided expansion of Medicaid.” Citing his constituents’ rejection of the ACA at the polls, Remole quotes famed orator Patrick Henry: “The Constitution is not an instrument for the government to restrain the people; it is an instrument for the people to restrain the government.”